Full neurological recovery from profound (18.0 C) acute accidental hypothermia: successful resuscitation using active invasive rewarming techniques

Abstract

The case of a 17-year-old girl brought into the emergency department (ED) having been found in a field semi-clad and overtly hypothermic is reported. A weak carotid pulse, agonal breathing and fixed dilated pupils were noted. On arrival in the ED she was in asystolic cardiopulmonary arrest. Initial core body temperature was 18 degrees C. After 4 h of closed cardiopulmonary resuscitation and rewarming using a haemofiltration circuit, she made a full recovery with no adverse neurological sequelae. In this case report, the importance of prolonged resuscitation in cardiopulmonary arrest secondary to acute severe environmental hypothermia and the successful use of a haemofiltration circuit to deliver active core rewarming are highlighted.

Neurologic Recovery From Profound Accidental Hypothermia After 5 Hours of Cardiopulmonary Resuscitation

“…Survival with no or minor neurologic impairment after profound accidental hypothermia and cardiac arrest is possible even when a number of hours of CPR is required before the initiation of extracorporeal rewarming, such as can occur in nonasphyxiated victims of mountain accidents (7)(8)(9)(10)(11)(12). According to a recent review (3), our case with a CPR duration of 5 hours in accidental hypothermia should represent the longest reported duration of CPR leading to good neurologic recovery.…”

Accidental hypothermia and local cold injury: physiological and epidemiological studies on risk

“…There have been a number of case reports which describe extreme hypothermia, heroic rescue and rewarming, and even survival (Gilbert 2000, Hughes A 2007, though none of these case reports have contradicted the findings of the non-survivability of immersion in cold water for more than 110 minutes.…”

Management of severe accidental hypothermia

“…A hospital lacking these techniques but with a critical care unit could resort to continuous venous---venous hemofiltration and hemoperfusion (CVVHP). 55,56 Promoting the latter technique in second level hospitals or centers with critical care units would offer an alternative in the organization Figure 4 Algorithm for the management of accidental hypothermia in an Intensive Care Unit.…”